Sacral neuromodulator interstim surgical site infection: Two case reports

Objective: The surgical site infection rate of sacral neuromodulator placement for the treatment of refractory urge urinary incontinence is reported to be between 5% and 7.9%. Our objective was to report the investigation process of these infections and a possible source for their occurrence. Methods: We performed infection control surveillance of two patients that underwent sacral neuromodulator placement on the same date, in the same operating room, and by the same staff who developed similar sacral cellulitis postoperatively. Results: The investigation revealed Staphylococcus aureus infections with a common antibiogram in both patients. Nasal cultures of all personnel involved in their care, showed Staphylococcus aureus with the same antibiogram only in a Medtronic representative who had manipulated the InterStim settings. Genetic analysis showed this to be an identical strain in one patient infection. Conclusions: The postoperative manipulation of device settings may be a source of surgical site infection, and infection control practices including strict hand washing, gloves, gown and mask may be warranted.